Bits and Bites

Digital dentistry is here, and it’s transforming offices and patient care

By Suzanne Bowness

Twelve years ago, Jaffer Kermalli 0T8, 1T1 MSc Perio invested in a cone beam computed tomography (CT) scanner, then an intraoral scanner and software to help him do virtual implant planning and guided surgery.

“It’s a very convenient workflow for the patients. For us, we’re able to control the fees. Patients are coming out with a nice package price, the practice consults for everything, and it all happens under one roof,” says Kermalli. Over time, he and his team have found that 3D printing in house has been less effective, and have returned to using a lab to produce top-quality implants.

Kermalli, who is also an instructor at the Faculty of Dentistry, has been sharing his digital dentistry success story with his study club of referring dentists. Half of them have invested in an intraoral scanner as a result. “There’s a large financial barrier, and people don’t want to drop $50,000 on a technology unless they know it’s going to work and make their life better, but then they hear from you about how well it works.”

If put in place properly, tech tools can improve workflow and the patient experience. Teched-up offices can set themselves apart. “Dentists are excited about how they can differentiate themselves amongst their peers, through technology, through office design, and through elevated patient experience,” says Prashant Ohri, president of dental equipment distributor Henry Schein Canada.

COSTS AND TRANSFORMATION
Outfitting a digital office comes with significant up-front costs, plus ongoing expenses related to software upgrades and maintenance — with training also adding to extra fees and requiring staff time. A 2022 study released by the American Dental Association (ADA) showed expenses rising by 7.7 per cent from the previous year, despite dentists working 4.5 per cent more hours. Inflation and the cost of technology are likely behind this rise.

More reliance on big-investment technology has contributed to the decline in numbers of solo practices — the ADA reports that two in three dentists worked alone in 1999, but that was closer to one in two by 2019, while Canadian practices likely follow a similar trend — and the rise of dental service organizations (DSOs). Many of these corporate entities back large practices where dentists can share hardware and software, while head office buys in bulk. As well, these companies often ink partnerships with tech companies for even more affordable access to new products. For instance, last May, dentalcorp signed with Bluelight Analytics for access to light curing and other technologies.

PATIENTS FIRST
The most frequently embraced technologies improve the patient experience. Software packages that help design treatment plans, plus make results sharable with patients for better buy-in, are high on wish lists. So are tools that reduce the number of patient visits, such as 3D printers and intraoral scanners. According to Ohri, the former is the hottest in-demand product currently and the latter is close to tipping over into mainstream use. “Five years ago, we would read about people debating digital scanners and their accuracy. Today, I think clinician adoption is closer to 35 to 40 per cent of dentists,” he says.

Patients take notice of these upgrades as well. According to a 2019 survey by Carestream Dental of 7,000 adults across seven global markets, including Canada, two out of three patients would consider switching to a dentist who uses more advanced technology. Patients are nearly twice as likely to report a positive experience when dental technology is used.

Toronto orthodontist Bradley Lands says that chatter has started among patients about his favourite tool, the intraoral scanner that he began using about eight years ago. “Patients love it. The funniest thing is parents who come in with their kids, they’re still scarred from having had those alginate impressions. We hear almost daily, ‘You’re so lucky. You don’t have that goopy stuff,’” he says, adding that from a dental perspective the scans create better-fitting appliances and less worry over storing and transporting the alginate, which can sag out of shape without proper care.

For prosthodontist Effrat Habsha 9T5, 9T8 Dip Prostho, 0T0 MSc Prostho, adopting digital photography and radiography, along with scanners and surgical guidance systems, has made a big change in her Toronto practice. Software allows her to stitch images from multiple angles and sources together, plus add the patient’s face in three dimensions, so she can better analyze the surgical approach and communicate her treatment plan. She can provide her patients with a more accurate sense of the end result, a key element in gaining their confidence before they make the investment. “It’s very compelling from a patient standpoint that they can visualize what their cosmetic outcome will be at the end of treatment,” says Habsha.

PRECISION DENTISTRY
Habsha says she’s impressed by the improvements to intraoral scanners in the last few years, noting that she uses them more now, to scan everything from single teeth to full arches. Dedicated software that helps her to plan implant placement combined with navigational aids have transformed surgery. “In the implant realm, there’s tremendous benefit in terms of less post-operative discomfort and swelling, bruising and bleeding, because we have less invasive surgery,” she says, comparing this highly accurate approach that uses a smaller incision to laparoscopic procedures in medicine.

Lands, similarly, relies on treatment planning software to make sure his approach with Invisalign or traditional braces will integrate with any restorative elements such as crowns and bridges that a patient may require in time, generating a whole-mouth plan. “We can get our spacing really precise, and show patients what things might look like afterwards, even if they have more dental work to do. It’s gotten really powerful on that side,” he says.

Also, for braces, Lands can use software to make a digital plan that creates custom wires for the patient, enabling more precision and cutting a few months off the total treatment time. The collaborative elements of the software also allow Lands to plan treatments with oral surgeons when they step in for their role in a complex treatment plan.

Habsha often takes advantage of the collaborative benefits of the latest software. Some tools have become so operator-friendly that she can assign staff members to do tasks that previously only she could handle. “It allows me to have my assistant take pre-treatment scans, and set the location of the crown for me to come in and scan. So, it increases my efficiency,” she says. She also saves time with the ability to review the images before they go to the lab and redo them if necessary. “You don’t have to send it to the lab only to discover that it was not appropriate,” says Habsha. “You can see in real time as you’re prepping patients. That is very helpful because you’re sending something out that’s good quality.” For Habsha, all of these elements add up to the same benefit. “I know my productivity is increased because I’m able to do more in a better way in a shorter period of time,” she says.

Improving dentists’ productivity is clearly a goal for many dental manufacturers. At Dentsply Sirona, ease of use and automation were major goals for their latest 3D medical-grade printer. It uses cartridges that are inserted into the printer without the operator having to touch any material, and the smart software alerts the user to any issues, so it can be operated by a non-specialist. Henry Schein’s practice management system aims to improve productivity by pulling together multiple programs, including dental analytics, patient communication and marketing, practice development and more to help dentists run their clinics more smoothly.

TECH KEEPS RISING
For digital dentistry to inch even further toward the mainstream, costs must come down while tools need to become increasingly precise. Ohri adds that improved compatibility between different devices and software packages will make a difference in allowing dentists to mix and match multiple brands. “The biggest opportunity for manufacturers is to create solutions that are open architecture,” he says.

As for what tech-savvy dentists would like to see in the future, Kermalli looks forward to better integration of CT scans with other imaging. Lands says he’s excited about what artificial intelligence (AI) can do for dentistry.

Indeed, dentists can expect AI — which already fills in gaps from incomplete scans by working in the background — will likely aid more in analytics to analyze and annotate images, helping dentists to more quickly evaluate scans. Dental magnetic resonance imaging (MRI) could become a key tool in future, which is why Dentsply Sirona is conducting research into its viability. “We think that dental MRIs will at some point be something that you will find in a lot of dental offices, certainly specialists’ offices,” says Julie Amyot, the company’s national manager of institutions and government. Besides their potential to help diagnose oral cancers, more machines in dental offices could offer greater accessibility for MRI facial and cranial scanning, which could improve access to care.

A tech-heavy future will ultimately be driven by dentists, first by these early adopters and then by those who begin to see the benefits to their practices. The industry will need to get better at assessing the return on investment of digital dentistry and, ideally, connect that return to better outcomes for patients.

Training has to become accessible, too. That’s already happening — Lands says that the process of learning about new tools has become easier with readily available continuing education programs, study clubs and trade journals. Kermalli keeps an eye on Instagram and YouTube, where other dentists post about their technology.

Where it’s all going is toward a seamless ecosystem of digital communications, record keeping, treatment planning and execution, all underpinned by the usual attention to detail, precise hand skills, and care and compassion that make dentistry both technical and human. “These are tools that improve outcomes — clinical outcomes, patient outcomes and lab outcomes,” says Habsha. “But at the end of the day, these are just tools. You still have to have the fundamentals.”

Top illustration: Greg Mably

Interested in more stories? Read the PDF edition of the U of T Dentistry Magazine Winter/Spring 2024 Issue